Pulp Capping Of Permanent Teeth Research Articles

Efficacy of different calcium silicate materials as pulp-capping agents: Randomized clinical trial

Background/purposeCalcium hydroxide-based materials were the gold standard in vital pulp therapies for decades’ despite of several shortcomings. However, calcium silicates have been discussed as an alternative to overcome these drawbacks. It was aimed to investigate the in-vivo effectiveness of different calcium silicates based materials in pulp capping in this study. Materials and methodsA parallel-design, randomized controlled trial with 213 patients who has deep dentin caries, vital pulps and without spontaneous pain or history of swelling was designed. 525 M teeth were randomized, blinded and allocated to one of the five groups for pulp capping treatment (n = 105). All teeth were followed up clinically and radiographically (after 1st, 6th, 12th and 36th months) by blinded investigators. The clinical and radiographic success, and the effect of the pulp exposure to the success rate analyzed with Wald chi-square and Z tests. ResultsClinical and radiographic success of MTA+ (86.3%, 85.4%) and Biodentine (79.4%, 80.1%) were found the highest. Although results of Theracal LC group (72.1%, 73.6%) were better than Dycal group (69.4%, 70.2%), the difference was nonsignificant (p > 0.05). Only in light-cured groups, (TheraCal LC & LC Calcihyd) pulpal exposure size effected the success of the materials (p < 0.05). MTA+ and Biodentine resulted better scores, when compared with TheraCal LC in large pulpal exposures (p < 0.05). ConclusionAfter 36-month follow-up, both MTA+ and Biodentine were found to be the appropriate material for direct pulp capping in permanent teeth. The filler ingredient of the Theracal-LC eases the usage of calcium silicates but decreases the success rate.

Efficacy of Er:YAG laser-assisted direct pulp capping in permanent teeth with cariously exposed pulp: A pilot study.

Direct pulp capping is a minimally invasive method to preserve pulp integrity. We evaluated the treatment efficacy of Er:YAG laser irradiation combined with direct pulp capping for pulp exposure due to caries. A total of 21 patients with 22 teeth were enrolled in the conventional group (calcium hydroxide), and 24 patients with 25 teeth were enrolled in the laser-assisted group (Er:YAG laser irradiation at settings of 10Hz, 50mJ; combined with calcium hydroxide). The cumulative success rate of the conventional group and the laser-assisted group was 68.2% and 91.7% at 12months, respectively. Results showed that the laser-assisted procedure increased the survival time (β=0.04, OR=0.07), while proximal-occlusal cavities in molars decreased the survival time (β=0.03, OR=12.5). Er:YAG lasers improve the effectiveness of conventional direct pulp capping (using Dycal) with limited side-effects and can be applied clinically.

Comparative efficacy of calcarea phosphorica versus calcium hydroxide materials for the disinfection of remaining carious dentin in deep cavities: An In vivo study

Objectives: The aim of the study was to comparatively evaluate the efficacy of clinical and radiographic effects of calcarea phosphorica (CP) and calcium (Ca)(OH)2(Dycal) in indirect pulp capping of permanent teeth over a period of 6 months. Methodology: Permanent teeth were selected from children between the age group of 7 and 12 years, of which 20 teeth were considered, each for indirect pulp capping with CP and Ca(OH)2, respectively. Increase in dentin thickness was measured at baseline, 3 month, and 6 month on digitized radiographs using CorelDraw software. Results: Independent t-test had indicated that at the end of 3 and 6 months, a statically significant increase in dentin thickness with both CP and Dycal (P ≤ 0.001) was found within the CP group; the thickness of dentin formed was 0.089 mm ± 0.031 mm at first 3 months and 0.055 ± 0.022 mm at the second 3 months (P ≤ 0.001) evaluated using paired t-test. In the Dycal group, increment in dentin deposited was 0.068 mm at the first 3 months and second 3 months. It was 0.030 mm (P ≤ 0.001). Conclusion: Both clinically and radio graphically, CP is superior to Dycal as indirect pulp capping medicament in permanent teeth.

Direct pulp capping in permanent teeth in children – tertiary dentin formation, materials used. Part II

Direct pulp capping involves placing therapeutic material on mechanically or traumatically exposed pulp. The most essential requirement of therapeutic success is clinical state of the pulp which should be healthy or in reversible pulpitis. The method is particularly recommended for young permanent teeth due to the high regenerative potential of dental pulp. The mechanisms underlying these repair processes involve the ability of odontoblasts to form dentin bridges via tertiary dentin deposition. If pulp exposure occurs, a layer of odontoblasts is killed and must be replaced with a new odontoblastic population, which differentiates from pulpal stem cells under the influence of a therapeutic agent applied on the pulp. In addition to odontotropic properties and the ability to stimulate production of qualitatively satisfying dentinal bridge, the substance used for pulp capping should be biocompatible, not stain dental tissues, exhibit good adhesion to them, and insolubility in dentin tubule fluid or water. So far an agent which meets all the requirements mentioned above has not been invented. It is crucial to continue research to develop a substance that will yield the best effects in direct pulp capping.

Direct pulp capping in permanent teeth in children – types of pulp exposure, therapeutic indications. Part I

Direct pulp capping, as a method allowing the preservation of viable and healthy pulp, is a key element in the treatment of immature permanent teeth. Maintaining pulp vitality is a condition for continuous root development, which is important for long-term maintenance of the tooth in the oral cavity. Therefore, the maintenance of vital pulp should be one of the main goals in the treatment of young permanent teeth and biological treatment is particularly recommended in such cases. Since young pulp has a great regenerative potential, the success rates of direct pulp capping are high. Therapeutic indications for this method include traumatic and mechanical exposure of either healthy or reversibly inflamed pulp. Accurate assessment of the clinical condition of the tooth is crucial for the choice of the most appropriate treatment option. Another crucial issue is proper understanding of the mechanisms that occur in the pulp as a result of treatment. Choice of a therapeutic agent, such as commonly used non-setting calcium hydroxide or MTA is also essential. However, other, less popular preparations should be also considered.

Frequently asked questions in direct pulp capping of permanent teeth.

Direct pulp capping is a proven method of preserving tooth vitality of a mature permanent tooth in cases of pulp exposures. The indications for this treatment, treatment modalities and materials are discussed in this paper. This paper answers many of the frequently asked questions by general practitioners, dental students and specialists about direct pulp capping.

Effect of mineral trioxide aggregate as a direct pulp capping agent in cariously exposed permanent teeth

Aims and Objectives: To evaluate the effectiveness of mineral trioxide aggregate (MTA) when used as a pulp capping agent in permanent teeth with carious exposure (≤1mm) after root formation is completed. Materials and Methods: Clinical follow-up was performed on 32 mandibular molars with deep occlusal caries, in patients in the age group range of 18 to 42 years. Carious pulpal exposures were treated by direct pulp capping with MTA, followed by a base of light cure glass ionomer cement and restored with amalgam. Clinical and radiographic examinations were carried out periodically at 1, 3, 6, 9, 12, 18 and 24 months. Results: After 24 months clinical and radiographic follow-up, it was found that 25 (out of 32) patients had successful outcome. However, two patients failed to return for evaluation after permanent restoration, and five patients exhibited clinical failure. Conclusions: Mineral trioxide aggregate was found to be an effective material when used for direct pulp capping in permanent teeth. However, further investigations with a larger sample size are needed to support these findings.

Comparison of CaOH with MTA for Direct Pulp Capping

This practice-based, randomized clinical trial evaluated and compared the success of direct pulp capping in permanent teeth with MTA (mineral trioxide aggregate) or CaOH (calcium hydroxide). Thirty-five practices in Northwest PRECEDENT were randomized to perform direct pulp caps with either CaOH (16 practices) or MTA (19 practices). Three hundred seventy-six individuals received a direct pulp cap with CaOH (n = 181) or MTA (n = 195). They were followed for up to 2 yrs at regular recall appointments, or as dictated by tooth symptoms. The primary outcomes were the need for extraction or root canal therapy. Teeth were also evaluated for pulp vitality, and radiographs were taken at the dentist’s discretion. The probability of failure at 24 mos was 31.5% for CaOH vs. 19.7% for MTA (permutation log-rank test, p = .046). This large randomized clinical trial provided confirmatory evidence for a superior performance with MTA as a direct pulp-capping agent as compared with CaOH when evaluated in a practice-based research network for up to 2 yrs (ClinicalTrials.gov NCT00812887).

Direct pulp capping of permanent teeth in primates using a resorbable form of tricalcium phosphate ceramic

A resorbable ceramic was placed over 22 surgically created pulpal exposures in an experiment. Histological evidence showed that formation of a dentinal bridge took place by direct apposition on the pulpal tissues that were treated with a ceramic form of tricalcium phosphate. Formation of a dentinal bridge appears to be predictable. The bridge is contiguous and thick, pulpal inflammation is minimal, and odontoblasts ore observed directly under and in contact with the bridge. The ceramic form of tricalcium phosphate appears to enhance the formation of a dentinal bridge in contrast with the calcium hydroxide that was used as the control. A resorbable ceramic was placed over 22 surgically created pulpal exposures in an experiment. Histological evidence showed that formation of a dentinal bridge took place by direct apposition on the pulpal tissues that were treated with a ceramic form of tricalcium phosphate. Formation of a dentinal bridge appears to be predictable. The bridge is contiguous and thick, pulpal inflammation is minimal, and odontoblasts ore observed directly under and in contact with the bridge. The ceramic form of tricalcium phosphate appears to enhance the formation of a dentinal bridge in contrast with the calcium hydroxide that was used as the control.

A Report on Dental Caries in Ten Thousand Four Hundred Forty-Five University Students (1928–1930)

Calcium hydroxide-based materials were the gold standard in vital pulp therapies for decades’ despite of several shortcomings. However, calcium silicates have been discussed as an alternative to overcome these drawbacks. It was aimed to investigate the in-vivo effectiveness of different calcium silicates based materials in pulp capping in this study.A parallel-design, randomized controlled trial with 213 patients who has deep dentin caries, vital pulps and without spontaneous pain or history of swelling was designed. 525 M teeth were randomized, blinded and allocated to one of the five groups for pulp capping treatment (n = 105). All teeth were followed up clinically and radiographically (after 1st, 6th, 12th and 36th months) by blinded investigators. The clinical and radiographic success, and the effect of the pulp exposure to the success rate analyzed with Wald chi-square and Z tests.Clinical and radiographic success of MTA+ (86.3%, 85.4%) and Biodentine (79.4%, 80.1%) were found the highest. Although results of Theracal LC group (72.1%, 73.6%) were better than Dycal group (69.4%, 70.2%), the difference was nonsignificant (p > 0.05). Only in light-cured groups, (TheraCal LC & LC Calcihyd) pulpal exposure size effected the success of the materials (p < 0.05). MTA+ and Biodentine resulted better scores, when compared with TheraCal LC in large pulpal exposures (p < 0.05).After 36-month follow-up, both MTA+ and Biodentine were found to be the appropriate material for direct pulp capping in permanent teeth. The filler ingredient of the Theracal-LC eases the usage of calcium silicates but decreases the success rate.